I usually find this when baby is presenting to Peds for a 24-48 hour follow up and has lost significant weight. I have found that breast compressions during infants entire feeding helps to transfer more milk. For some babies I have also noticed that if mother puts the baby in 2 different positions on each breast this helps as well. Depending on what the end transfer is with all of these trials I give the parents options to choose from SNS at the breast and pumping and supplementing via cup, bottle, spoon. 
I can usually tell right from the beginning if SNS is going to be a good option for the family or not. The families that it works well for are mothers who are comfortable holding baby or if dad is involved. 
If it looks like mother could benefit from having an additional hand to two just to get baby latched onto the breast the SNS may be to much and it just might push mother over the edge. 

I have also tried and had a few successful cases of using a large nipple shield. This tends to work better for mothers who have very long nipples and baby gags on the nipple when nursing. 

It is encouraging for mothers to know that the babies mouth will grow so this is a temporary process. 

Jess Callahan IBCLC
NC, USA

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